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Limitations of ST analysis in clinical practice: three cases of intrapartum metabolic acidosis
Article first published online: 15 MAY 2007
DOI: 10.1111/j.1471-0528.2007.01236.x
RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 114, Issue 10, pages 1194–1201, October 2007
Additional Information
How to Cite
Westerhuis, M., Kwee, A., Van Ginkel, A., Drogtrop, A., Gyselaers, W. and Visser, G. (2007), Limitations of ST analysis in clinical practice: three cases of intrapartum metabolic acidosis. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 1194–1201. doi: 10.1111/j.1471-0528.2007.01236.x
Publication History
- Issue published online: 15 MAY 2007
- Article first published online: 15 MAY 2007
- Accepted 28 November 2006. Published OnlineEarly 15 May 2007.
- Abstract
- Article
- References
- Cited By
Keywords:
- Cardiotocography;
- fetal electrocardiogram;
- fetal metabolic acidosis;
- intrapartum fetal monitoring;
- ST analysis
Objective To examine detailed intrapartum events in cases of neonatal metabolic acidosis despite monitoring using STAN® (cardiotocography [CTG] plus ST waveform analysis of fetal electrocardiogram [ECG]).
Design Retrospective case review.
Setting High-risk pregnancies monitored by STAN®.
Methods Case note review was performed in newborns with metabolic acidosis where no significant ST changes in the fetal ECG occurred prior to birth.
Main outcome measures Metabolic acidosis.
Results Detailed review of three cases identified poor signal quality, difficulties in CTG interpretation, failure to comply with STAN® clinical guidelines and deterioration of the CTG without ECG alert as the leading causes of these adverse outcomes.
Conclusions The cases illustrate some of the pitfalls associated with the clinical application of the STAN® technology which prevent severe metabolic acidosis being eradicated completely. It may be useful to expand the STAN® guidelines protocol towards the identification of exceptional clinical situations, such as in our cases, and towards appropriate additional interventions, as this may lead to a further reduction in adverse neonatal outcomes.